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American Journal of Epidemiology Advance Access originally published online on May 27, 2009
American Journal of Epidemiology 2009 170(2):257-265; doi:10.1093/aje/kwp116
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American Journal of Epidemiology © The Author 2009. Published by the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org.

PRACTICE OF EPIDEMIOLOGY

Dynamics and Control of Infections Transmitted From Person to Person Through the Environment

Sheng Li, Joseph N. S. Eisenberg, Ian H. Spicknall and James S. Koopman

Correspondence to Dr. Joseph N. S. Eisenberg, Department of Epidemiology, University of Michigan, 109 South Observatory Street, Ann Arbor, MI 48109 (e-mail: jnse{at}umich.edu).

Received for publication November 17, 2008. Accepted for publication April 13, 2009.

The environment provides points for control of pathogens spread by food, water, hands, air, or fomites. These environmental transmission pathways require contact network formulations more realistically detailed than those based on social encounters or physical proximity. As a step toward improved assessment of environmental interventions, description of contact networks, and better use of environmental specimens to analyze transmission, an environmental infection transmission system model that describes the dynamics of human interaction with pathogens in the environment is presented. Its environmental parameters include the pathogen elimination rate, µ, and the rate humans pick up pathogens, {rho}, and deposit them, {alpha}. The ratio, {rho}N/µ (N equals population size), indicates whether transmission is density dependent (low ratio), frequency dependent (high ratio), or in between. Transmission through frequently touched fomites, such as doorknobs, generates frequency-dependent patterns, while transmission through thoroughly mixed air or infrequently touched fomites generates density-dependent patterns. The environmental contamination ratio, {alpha}/{gamma}, reflects total agent deposition per infection and outbreak probability, where {gamma} is defined as the recovery rate. These insights provide theoretical contexts to examine the role of the environment in pathogen transmission and a framework to interpret environmental data to inform environmental interventions.

communicable diseases; disease transmission, infectious; environmental medicine; environment and public health; epidemiologic methods; fomites; influenza, human; intervention studies

Abbreviations: EITS, environmental infection transmission system; SIR, susceptible-infectious-recovered


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